Adult Intermittent Self-Catheterization Patient Fact Sheet - SUNA

Adult Intermittent Self-CatheterizationPatient Fact SheetThe bladder is a hollow muscular organ shaped like a smallballoon that is located in the lower abdomen. The kidneys, (beanshapedorgans near the middle of the back), normally removeexcess water and waste products from the bloodstream and storeit as urine in the bladder. The rate at which urine is produceddepends on fluid intake, activity, and environmental temperature.As the bladder fills with urine over several hours, a normal bladderwill send signals to the brain that the bladder is full and needsto empty.Most people empty their bladders by voluntarily going to thebathroom four or five times a day. This is called urinating orvoiding. When the bladder is not emptied of all urine, problemscan occur.Intermittent Self-Catheterization (ISC) is a safe and effectivealternative method to empty the bladder. ISC involves insertinga catheter (a flexible hollow tube) into the urethra (the urine channelthat drains urine from the bladder) several times a day. ISC isused to help protect the kidneys, prevent incontinence (urine leakage)and lessen the number of infections by promoting gooddrainage of the bladder while lowering pressure inside the bladder.It has been used successfully for individuals with injury tothe nerves of the bladder, spinal cord and brain as well as in personswith diabetes, multiple sclerosis, spina bifida, myelodysplasia,enlarged prostate and continent urinary diversion. It can bedone on a short or long term basis, depending on the bladder’sability or inability to return to normal function.How to perform ISC:ISC is performed by intermittently inserting a catheter intothe urethral opening (meatus) and advancing it into the bladder toallow the bladder to empty. Only persons who know the correcttechnique of proper insertion and care of the catheter should performcatheterization.It is recommended that ISC be performed at regular intervalsthroughout the day depending on the person’s fluid intake and asdirected by the healthcare provider. The ability to performcatheterization and adhere to a schedule is essential to success ofthe ISC program. You may need to catheterize every four to sixhours to keep the amount of urine in your bladder less than 400-500 milliliters (13 to 15 ounces). If you are urinating but continuewith high residual urine volumes (the amount left in your bladderafter urinating) your healthcare provider may ask you toincrease the number of times per day you catheterize.Many persons will catheterize using a “clean” method,which means you do not need to wear gloves, just wash yourhands with soap and water before catheterizing. It is recommendedthat you use a new catheter each time you catheterize. Foralternatives to using each catheter only once, discuss this withyour healthcare provider who prescribed the ISC for you.Materials needed to prepare:• Soap and water to wash hands and the urethral opening. If soapand water are not readily available, waterless alcohol-basedhand rub or towelettes may be used.• Urethral catheter (male or female). The size of the cathetershould be the smallest size (called a “French” size) to pass easilyinto the bladder and allow adequate drainage.• The correct type and size of the catheter to be used will be determinedby the healthcare provider.• Lubricant (water soluble jelly) packet or tube.• Urinal or appropriate container to collect drained urine (if notemptying into a toilet).• Mirror (for women to locate the opening of the urethra).Set up:• Gather all the necessary products before beginning the procedure.• Males and females must be instructed on the locations of basicstructures in the area of the genital anatomy and urinary openingwith proper procedure before they do the procedure on theirown.Females:• Wash hands thoroughly with soap and water or use a waterlessalcohol-based hand rub or towelette.• Find a comfortable position.• Spread the labia apart using the hand you will not be using tohold the catheter.• Clean the entire urethral opening (meatus) area from front toback with warm, soapy water and a clean washcloth or towelette(when away from home).• Use a mirror initially to aid in the location of the meatal openingif needed. It is located below the clitoris and just above thevagina in most females, visually seen as “^”.• Lubricate the tip of the catheter with the water-soluble jelly.This material is for educational purposes only and should in no way be taken to be the practice or provision of medical, nursing or professional healthcareadvice or services.The information should not be used in place of a visit, call, consultation or advice of your physician, nurse or other health care provider.The information obtained herein is not exhaustive and does not cover all aspects of the specific disease, ailment, physical condition or their treatments. Shouldyou have any health care related questions, please call or see your physician, nurse or other health care provider promptly.The Society of Urologic Nurses and Associates is a professional organization committed to excellence in clinical practice and research through education ofits members, patients, family, and community.© 2010 Society of Urologic Nurses and AssociatesFor more information, contact:Society of Urologic Nurses and AssociatesEast Holly Avenue Box 56Pitman, NJ 08071-0056Phone 888-TAP-SUNA or 856-256-2335suna@ajj.comwww.suna.org

• Rotate the tip to spread the lubricant along the entire length of thecatheter.• With a collection container ready, slowly and gently insert thecatheter (2-4 inches) into the meatus until urine begins to flow.• If resistance is felt at the internal sphincter, hold firm, gentle,steady pressure and the muscles should relax allowing thecatheter to pass. You can also cough or take a few slow, deepbreaths to relax your sphincter.• Allow the urine to empty into the collection container or into thetoilet.• When the urine flow stops, slowly withdraw the catheter allowingthe lower parts of the bladder to drain. When there is no furtherflow of urine, remove the catheter.• If requested by the healthcare provider prescribing the catheterization,record the amount of urine.• Wipe yourself with tissue from front to back and discard the usedcatheter.• Wash hands thoroughly with soap and water.Males:• Wash hands thoroughly with soap and water or use a waterlessalcohol-based hand rub or towelette.• Find a comfortable position. Some men prefer to stand for theprocedure but it can be done just as easily in the sitting position.• Hold the penis in an upright position (pointing towards the bellybutton) and wash the urethral opening (meatus) with soapy waterand a clean washcloth or towelette (when away from home). Foruncircumcised men, pull back the foreskin first and clean themeatus in the same way.• Lubricate the tip of the catheter with the water-soluble jelly.• Rotate the tip to spread the lubricant along the entire length of thecatheter.• With a collection container ready, slowly and gently insert thecatheter into the meatus, approximately 6-8 inches or until urinebegins to flow. Often the entire length of the catheter must beinserted (to the hub or end of the catheter) for urine flow to occur.• There may be some resistance to the passage of the catheter halfway through the urethra, at the part of the urethra where thesphincter (valve) and prostate gland is found. If this happens,hold firm, gentle, steady pressure and the sphincter will open.Muscle relaxation will be felt and the catheter will advancethrough this part of the urethra. You can also cough or take a fewslow, deep breaths to relax your sphincter.• There may also be resistance at the bottom of the bladder (calledthe “bladder neck”) which has another sphincter. Using firm,gentle, steady pressure should cause this part of the bladder toopen and allow the catheter to pass into the bladder. If not, bearingdown or pushing down or a strong cough may also relax thismuscle so you can pass the catheter.• Once inside the bladder, keep the catheter in place until the flowof urine stops. As soon as urine starts to flow, point your penisdownwards over collection container or toilet. Slowly and gentlywithdraw the catheter allowing for any pockets of urine at thebase of the bladder to drain. When there is no further flow ofurine, remove the catheter.• If requested by your healthcare provider, record the amount ofurine drained from your bladder.• Discard the used catheter.• Wash hands thoroughly with soap and water.Intermittent Self-Catheterization Tips:• Never force the catheter. Difficulty inserting a straight catheteror being unable to catheterize may require you to see a urologist.Coudé tipped catheters often are able to successfully pass intothe bladder when catheterization with a straight catheter is difficult.Coudé catheters have a special curve at the tip that makespassage through the urethra easier.• If you are at home and unable to pass the catheter and feel thatyour bladder is full, you will need to go to your nearest UrgentCare Center/Emergency Room for appropriate evaluation.• It is not uncommon to have an abnormal urinalysis (urine test).You should only be treated for a urinary tract infection if youhave signs and symptoms of an infection such as tenderness inyour lower abdomen or pelvic area, back pain, malaise, confusion,cloudy or foul-smelling urine, urgency (pressing need tourinate), frequency (urinating more often than usual), pain withurination, fever higher than 100.4 F, and/or chills, nausea andvomiting. Contact your healthcare provider if these symptomsoccur.• For patients who have Multiple Sclerosis or other conditions thatmay compromise their immune system, ISC may need to be performedusing sterile technique which is when you use sterilegloves, antiseptic to wipe the area where the catheter is insertedand a sterile catheter each time you catheterize. Contact yourUrologist for guidance.Points to remember:• Do not remove the catheter from the package until ready to use.• Check the catheter for defects such as cracks or color changesbefore use.• Avoid touching the tip of the catheter and avoid letting it touchother surfaces.• A prescription or order from a healthcare provider is needed tostate the number of times an individual catheterizes each day.Check with your individual insurance carrier to see which benefitsare available to you.• This fact sheet focuses on the adult patient. Children require specialassessment and teaching to be successful. Contact yourPediatric Urologist for guidance.• If you perform ISC and encounter any problems, call yourhealthcare provider for timely advice.Authors:Katy Bortel, MS, RN, CCRPDebbie L. Hensley, BSN, RN, CURNEvelyn M. Kliever, MA, RN, CURNTheresa A. Lesher, BSN, CURNDiane Newman, MSN, RNC, CRNP, FAAN